<h3>MOH - Uganda - January 2012</h3>

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    <!-- ARV PAGE 1 --></p>
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            <td colspan="15">
                <div class="cent">
                    <h3>
                        Joint Medical Store&nbsp;(Global Fund)</h3>
                </div>
                <div class="bold" style="padding-bottom:15px; padding-top:10px; color:#de2c2c; font-size:14px;">
                    Please adhere to these instructions</div>
                <div style="padding-bottom:15px; color:#101010; font-size:14px;">
                    i. Please ensure to report in <span class="bold">pack sizes</span>. For example, instead of recording 60 tablets for AZT/3TC/NVP, record 1 pack.</div>
                <div style="padding-bottom:15px; color:#101010; font-size:14px;">
                    ii. Please note that the ARV order and report form is a bi-monthly report. Therefore combine and enter data for two months into a single report when filling the form. Selecting a month in the period field above implies that you are entering data for the selected month and the month before. For example, selecting February 2012 means you are entering aggregated data for January 2012 and February 2012.</div>
            </td>
        </tr>
        <tr>
            <th>
                &nbsp;</th>
            <th>
                Drug Formulation and Strength</th>
            <th>
                Pack Size</th>
            <th>
                OPENING BALANCE at start of 2 Month Cycle</th>
            <th>
                QUANTITY RECEIVED during 2 Month Cycle</th>
            <th>
                PMTCT CONSUMPTION during 2 Month Cycle</th>
            <th>
                ART<br />
                CONSUMPTION during 2 Month Cycle</th>
            <th>
                LOSSES / ADJUSTMENTS ( + / - )</th>
            <th>
                CLOSING BALANCE (Physical Count Stores + Pharmacy)</th>
            <th>
                MONTHS OF STOCK ON-HAND = F / ((C+D) / 2)</th>
            <th>
                QUANTITY REQUIRED FOR CURRENT PATIENTS = (2 x (C+D) - F</th>
            <th>
                ESTIMATED NO OF NEW ART PATIENTS for the Next Cycle</th>
            <th>
                ESTIMATED<br />
                NO OF&nbsp;NEW HIV+ PREGNANT WOMEN&nbsp;for the Next Cycle</th>
            <th>
                TOTAL QUANTITY TO BE ORDERED = G + (H * p * 4)</th>
            <th>
                Notes</th>
        </tr>
        <tr>
            <th colspan="3">
                ADULT&nbsp;- RECOMMENDED FORMULATIONS</th>
            <th>
                A</th>
            <th>
                B</th>
            <th>
                C</th>
            <th>
                D</th>
            <th>
                E</th>
            <th>
                F</th>
            <th>
                G</th>
            <th>
                H</th>
            <th>
                I</th>
            <th>
                J</th>
            <th>
                K</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) 300mg/300mg/600mg</td>
            <td class="alt">
                Pack of 30</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                2</td>
            <td>
                960</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                3520</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg</td>
            <td>
                Pack of&nbsp;30</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                2</td>
            <td>
                960</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                3520</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) 300mg/150mg/200mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                2</td>
            <td>
                960</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                3520</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                4</td>
            <td>
                Zidovudine/Lamivudine (AZT/3TC) 300mg/150mg</td>
            <td>
                Pack of 60</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                2</td>
            <td>
                960</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                3520</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                5</td>
            <td class="alt">
                Efavirenz (EFV) 600mg</td>
            <td class="alt">
                Pack of 30</td>
            <td>
                160</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                4</td>
            <td>
                320</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                1600</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                6</td>
            <td>
                Nevirapine (NVP) 200mg</td>
            <td>
                Pack of 60</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                2</td>
            <td>
                960</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                3520</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                7</td>
            <td class="alt">
                Atazanavir/Ritonavir (ATV/r) 300mg/100mg</td>
            <td class="alt">
                Pack of 30</td>
            <td>
                160</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                4</td>
            <td>
                320</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                1600</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                8</td>
            <td>
                Lopinavir/Ritonavir (LPV/r) 200mg/50mg</td>
            <td>
                Pack&nbsp;of 120</td>
            <td>
                160</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                4</td>
            <td>
                320</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                320</td>
            <td>
                </td>
        </tr>
        <tr>
            <th>
                &nbsp;</th>
            <th>
                Drug Formulation and Strength</th>
            <th>
                Pack Size</th>
            <th>
                OPENING BALANCE at start of 2 Month Cycle</th>
            <th>
                QUANTITY RECEIVED during 2 Month Cycle</th>
            <th>
                PMTCT CONSUMPTION during 2 Month Cycle</th>
            <th>
                ART<br />
                CONSUMPTION during 2 Month Cycle</th>
            <th>
                LOSSES / ADJUSTMENTS ( + / - )</th>
            <th>
                CLOSING BALANCE (Physical Count Stores + Pharmacy)</th>
            <th>
                MONTHS OF STOCK ON-HAND = F / ((C+D) / 2)</th>
            <th>
                QUANTITY REQUIRED FOR CURRENT PATIENTS&nbsp;= (2 x (C+D) - F</th>
            <th>
                ESTIMATED NO OF NEW ART PATIENTS for the Next Cycle</th>
            <th>
                ESTIMATED<br />
                NO&nbsp;OF&nbsp;NEW HIV+ PREGNANT WOMEN&nbsp;for the Next Cycle</th>
            <th>
                TOTAL QUANTITY TO BE ORDERED = G + (H * p * 4)</th>
            <th>
                Notes</th>
        </tr>
        <tr>
            <th colspan="3">
                ADULT&nbsp;- FORMULATIONS</th>
            <th>
                A</th>
            <th>
                B</th>
            <th>
                C</th>
            <th>
                D</th>
            <th>
                E</th>
            <th>
                F</th>
            <th>
                G</th>
            <th>
                H</th>
            <th>
                I</th>
            <th>
                J</th>
            <th>
                K</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td class="alt">
                9</td>
            <td class="alt">
                Zidovudine (AZT) 300mg</td>
            <td class="alt">
                Pack of&nbsp;60</td>
            <td>
                160</td>
            <td>
                160</td>
            <td>
                160</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                160</td>
            <td>
                130</td>
            <td>
                3.2</td>
            <td>
                380</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                70</td>
            <td>
                940</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                10</td>
            <td>
                Lamivudine (3TC) 150mg</td>
            <td>
                Pack of 60</td>
            <td>
                130</td>
            <td>
                130</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                130</td>
            <td>
                130</td>
            <td>
                130</td>
            <td>
                4</td>
            <td>
                260</td>
            <td>
                70</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                820</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                11</td>
            <td class="alt">
                Abacavir (ABC) 300mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                60</td>
            <td>
                60</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                60</td>
            <td>
                60</td>
            <td>
                60</td>
            <td>
                4</td>
            <td>
                120</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                120</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                12</td>
            <td>
                Abacavir/Lamivudine (ABC/3TC) 600mg/300mg</td>
            <td>
                Pack of 30</td>
            <td>
                60</td>
            <td>
                60</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                60</td>
            <td>
                60</td>
            <td>
                60</td>
            <td>
                4</td>
            <td>
                120</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                120</td>
            <td>
                </td>
        </tr>
        <tr>
            <th>
                &nbsp;</th>
            <th>
                Drug Formulation and Strength</th>
            <th>
                Pack Size</th>
            <th>
                OPENING BALANCE at start of 2 Month Cycle</th>
            <th>
                QUANTITY RECEIVED during 2 Month Cycle</th>
            <th>
                PMTCT CONSUMPTION during 2 Month Cycle</th>
            <th>
                ART CONSUMPTION during 2 Month Cycle</th>
            <th>
                LOSSES / ADJUSTMENTS ( + / - )</th>
            <th>
                CLOSING BALANCE (Physical Count Stores + Pharmacy)</th>
            <th>
                MONTHS OF STOCK ON-HAND = F / ((C+D) / 2)</th>
            <th>
                QUANTITY REQUIRED FOR CURRENT PATIENTS&nbsp;= (2 x (C+D) - F</th>
            <th>
                ESTIMATED NO OF NEW ART PATIENTS for the Next Cycle</th>
            <th>
                ESTIMATED<br />
                NO&nbsp;OF&nbsp;NEW HIV+ PREGNANT WOMEN&nbsp;for the Next Cycle</th>
            <th>
                TOTAL QUANTITY TO BE ORDERED = G + (H * p * 4)</th>
            <th>
                Notes</th>
        </tr>
        <tr>
            <th colspan="3">
                PAEDIATRIC&nbsp;- RECOMMENDED FORMULATIONS</th>
            <th>
                A</th>
            <th>
                B</th>
            <th>
                C</th>
            <th>
                D</th>
            <th>
                E</th>
            <th>
                F</th>
            <th>
                G</th>
            <th>
                H</th>
            <th>
                I</th>
            <th>
                J</th>
            <th>
                K</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td>
                1</td>
            <td>
                Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) 60mg/30mg/50mg</td>
            <td>
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                2</td>
            <td class="alt">
                Zidovudine/Lamivudine (AZT/3TC) 60mg/30mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                3</td>
            <td>
                Abacavir/Lamivudine (ABC/3TC) 60mg/30mg</td>
            <td>
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                4</td>
            <td class="alt">
                Abacavir (ABC) 60mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                5</td>
            <td>
                Efavirenz (EFV) 200mg</td>
            <td>
                Pack of 90</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                6</td>
            <td class="alt">
                Nevirapine (NVP) 50mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                7</td>
            <td>
                Lopinavir/Ritonavir (LVP/r) 80mg/20ml oral susp.</td>
            <td>
                Bottle&nbsp;60 ml</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                8</td>
            <td class="alt">
                Lopinavir/Ritonavir (LVP/r) 100mg/25mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                9</td>
            <td>
                Efavirenz (EFV) 50mg</td>
            <td>
                Pack of 30</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
    </tbody>
</table>
<!-- ARV PAGE 2 -->
<table class="formSection" style="margin-bottom:20px">
    <colgroup>
        <col width="35px" />
        <col width="300px" />
        <col />
        <col />
        <col />
        <col />
        <col />
        <col />
        <col />
        <col />
        <col />
        <col />
    </colgroup>
    <tbody>
        <tr>
            <td colspan="15">
                <div class="cent">
                    <h3>
                        Joint Medical Store&nbsp;(Global Fund)</h3>
                </div>
            </td>
        </tr>
        <tr>
            <th>
                &nbsp;</th>
            <th>
                Drug Formulation and Strength</th>
            <th>
                Pack Size</th>
            <th>
                OPENING BALANCE at start of 2 Month Cycle</th>
            <th>
                QUANTITY RECEIVED during 2 Month Cycle</th>
            <th>
                PMTCT CONSUMPTION during 2 Month Cycle</th>
            <th>
                ART CONSUMPTION during 2 Month Cycle</th>
            <th>
                LOSSES / ADJUSTMENTS ( + / - )</th>
            <th>
                CLOSING BALANCE (Physical Count in Stores + Pharmacy)</th>
            <th>
                MONTHS OF STOCK ON-HAND = F / ((C+D) / 2)</th>
            <th>
                QUANTITY REQUIRED FOR CURRENT&nbsp;PATIENTS<br />
                = (2 x (C+D) - F</th>
            <th>
                ESTIMATED NUMBER OF ART NEW ART PATIENTS for the Next Cycle</th>
            <th>
                ESTIMATED<br />
                NO&nbsp;OF&nbsp;NEW HIV+ PREGNANT WOMEN&nbsp;for the Next Cycle</th>
            <th>
                TOTAL QUANTITY TO BE ORDERED = G + (H * p * 4)</th>
            <th>
                Notes</th>
        </tr>
        <tr>
            <th colspan="3">
                PAEDIATRIC - FORMULATIONS</th>
            <th>
                A</th>
            <th>
                B</th>
            <th>
                C</th>
            <th>
                D</th>
            <th>
                E</th>
            <th>
                F</th>
            <th>
                G</th>
            <th>
                H</th>
            <th>
                I</th>
            <th>
                J</th>
            <th>
                K</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td class="alt">
                10</td>
            <td class="alt">
                Stavudine/Lamivudine/Nevirapine (D4T/3TC/NVP) 6mg/30mg/50mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                11</td>
            <td>
                Stavudine/Lamivudine (D4T/3TC) 6mg/30mg</td>
            <td>
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                12</td>
            <td class="alt">
                Stavudine/Lamivudine/Nevirapine (D4T/3TC/NVP) 12mg/30mg/100mg</td>
            <td class="alt">
                Pack of 60</td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <th colspan="3">
                PMTCT ONLY FORMULATIONS</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                Nevirapine (NVP) 10mg/ml oral susp.</td>
            <td class="alt">
                Bottle 100 ml</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <th>
                &nbsp;</th>
            <th>
                Drug Formulation and Strength</th>
            <th>
                Pack Size</th>
            <th>
                OPENING BALANCE at start of 2 Month Cycle</th>
            <th>
                QUANTITY RECEIVED during 2 Month Cycle</th>
            <th>
                PMTCT CONSUMPTION during 2 Month Cycle</th>
            <th>
                ART CONSUMPTION during 2 Month Cycle</th>
            <th>
                LOSSES / ADJUSTMENTS ( + / - )</th>
            <th>
                CLOSING BALANCE (Physical Count Stores + Pharmacy)</th>
            <th>
                MONTHS OF STOCK ON-HAND = F / ((C+D) / 2)</th>
            <th>
                QUANTITY REQUIRED FOR CURRENT&nbsp;PATIENTS&nbsp;<br />
                = (2 x (C+D) - F</th>
            <th>
                ESTIMATED NO OF NEW ART PATIENTS for the Next Cycle</th>
            <th>
                ESTIMATED<br />
                NO&nbsp;OF&nbsp;NEW HIV+ PREGNANT WOMEN&nbsp;for the Next Cycle</th>
            <th>
                TOTAL QUANTITY TO BE ORDERED = G + (H * p * 4)</th>
            <th>
                Notes</th>
        </tr>
        <tr>
            <th colspan="3">
                OTHER FORMULATIONS</th>
            <th>
                A</th>
            <th>
                B</th>
            <th>
                C</th>
            <th>
                D</th>
            <th>
                E</th>
            <th>
                F</th>
            <th>
                G</th>
            <th>
                H</th>
            <th>
                I</th>
            <th>
                J</th>
            <th>
                K</th>
            <th>
                &nbsp;</th>
        </tr>
        <tr>
            <td>
                1</td>
            <td>
                Sulfamethoxazole/Trimethoprim (Cotrimoxazole) 800mg/160mg</td>
            <td>
                Pack of 1000</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                2</td>
            <td class="alt">
                Sulfamethoxazole/Trimethoprim (Cotrimoxazole) 100mg/20mg</td>
            <td class="alt">
                Pack of 1000</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                3</td>
            <td>
                Fluconazole (FL) 200mg</td>
            <td>
                Pack of&nbsp;28</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                4</td>
            <td class="alt">
                Fluconazole (FL) oral solution</td>
            <td class="alt">
                Bottle&nbsp;35 ml</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td>
                5</td>
            <td>
                Fluconazole (FL) IV</td>
            <td>
                IV 100 ml</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
        <tr>
            <td class="alt">
                6</td>
            <td class="alt">
                Dapsone 100mg</td>
            <td class="alt">
                Pack of 1000</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                0</td>
            <td>
                </td>
            <td>
                </td>
            <td>
                0</td>
            <td>
                </td>
        </tr>
    </tbody>
</table>
<p>
    <!-- FLUCONAZOLE PATIENTS --></p>
<table class="formSection" style="margin-bottom:20px">
    <colgroup>
        <col width="35px" />
        <col width="300px" />
        <col width="120px" />
        <col width="120px" />
    </colgroup>
    <tbody>
        <tr>
            <td colspan="4">
                <div class="cent">
                    <h3>
                        Patients Treated With Fluconazole</h3>
                </div>
            </td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                Patients treated for the following:</td>
            <td class="tabHead">
                Adults</td>
            <td class="tabHead">
                Children</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                Acute cryptococcal meningitis</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                Cryptococcal meningitis patients treated on maintenance therapy</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                Esophageal candidiasis</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
    </tbody>
</table>
<p>
    <!-- PMTCT PATIENTS --></p>
<table class="formSection" style="margin-bottom:20px">
    <colgroup>
        <col width="35px" />
        <col width="300px" />
        <col width="120px" />
        <col width="120px" />
    </colgroup>
    <tbody>
        <tr>
            <td colspan="4">
                <div class="cent">
                    <h3>
                        PMTCT Patients</h3>
                </div>
            </td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                PMTCT Patients by Regimen</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                TDF/3TC/EFV</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                TDF/3TC/NVP</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                AZT/3TC/NVP</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
    </tbody>
</table>
<p>
    <!-- ADULT ART PATIENTS --></p>
<table class="formSection" style="margin-bottom:20px">
    <colgroup>
        <col width="35px" />
        <col width="300px" />
        <col width="120px" />
        <col width="120px" />
    </colgroup>
    <tbody>
        <tr>
            <td colspan="4">
                <div class="cent">
                    <h3>
                        Adult ART Patients</h3>
                </div>
            </td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                1st Line Regiments</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                TDF/3TC/NVP</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                TDF/3TC/EFV</td>
            <td>
                100</td>
            <td>
                100</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                AZT/3TC/NVP</td>
            <td>
                100</td>
            <td>
                110</td>
        </tr>
        <tr>
            <td>
                4</td>
            <td>
                AZT/3TC/EFV</td>
            <td>
                110</td>
            <td>
                100</td>
        </tr>
        <tr>
            <td class="alt">
                5</td>
            <td class="alt">
                ABC/3TC/NVP</td>
            <td>
                91</td>
            <td>
                91</td>
        </tr>
        <tr>
            <td>
                6</td>
            <td>
                ABC/3TC/EFV</td>
            <td>
                91</td>
            <td>
                91</td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                2nd Line Regiments</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                TDF/3TC/ATV/r</td>
            <td>
                91</td>
            <td>
                91</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                TDF/3TC/LPV/r</td>
            <td>
                91</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                AZT/3TC/ATV/r</td>
            <td>
                91</td>
            <td>
                90</td>
        </tr>
        <tr>
            <td>
                4</td>
            <td>
                AZT/3TC/LPV/r</td>
            <td>
                91</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                Summary</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                &nbsp;</td>
            <td class="alt">
                TOTAL ADULT PATIENTS</td>
            <td>
                2032</td>
            <td>
                1666</td>
        </tr>
    </tbody>
</table>
<p>
    <!-- PEADIATRIC ART PATIENTS --></p>
<table class="formSection" style="margin-bottom:20px">
    <colgroup>
        <col width="35px" />
        <col width="300px" />
        <col width="120px" />
        <col width="120px" />
    </colgroup>
    <tbody>
        <tr>
            <td colspan="4">
                <div class="cent">
                    <h3>
                        Paediatric ART Patients (14 years and below)</h3>
                </div>
            </td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                1st Line Regiments</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                AZT/3TC/NVP</td>
            <td>
                92</td>
            <td>
                92</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                AZT/3TC/EFV</td>
            <td>
                91</td>
            <td>
                91</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                ABC/3TC/NVP</td>
            <td>
                100</td>
            <td>
                100</td>
        </tr>
        <tr>
            <td>
                4</td>
            <td>
                ABC/3TC/EFV</td>
            <td>
                110</td>
            <td>
                110</td>
        </tr>
        <tr>
            <td class="alt">
                5</td>
            <td class="alt">
                D4T/3TC/NVP</td>
            <td>
                140</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
        </tr>
        <tr>
            <td>
                6</td>
            <td>
                D4T/3TC/EFV</td>
            <td>
                140</td>
            <td style="background-color: rgb(224, 224, 224); ">
                &nbsp;</td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                2nd Line Regiments</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                1</td>
            <td class="alt">
                AZT/3TC/LPV/r</td>
            <td>
                160</td>
            <td>
                160</td>
        </tr>
        <tr>
            <td>
                2</td>
            <td>
                ABC/3TC/LPV/r</td>
            <td>
                190</td>
            <td>
                190</td>
        </tr>
        <tr>
            <td class="alt">
                3</td>
            <td class="alt">
                D4T/3TC/LPV/r</td>
            <td>
                91</td>
            <td>
                91</td>
        </tr>
        <tr>
            <td class="tabHead">
                &nbsp;</td>
            <td class="tabHead">
                Summary</td>
            <td class="tabHead">
                Existing</td>
            <td class="tabHead">
                New</td>
        </tr>
        <tr>
            <td class="alt">
                &nbsp;</td>
            <td class="alt">
                TOTAL PAEDIATRIC PATIENTS</td>
            <td>
                2228</td>
            <td>
                1668</td>
        </tr>
    </tbody>
</table>
<p style="font-size:14px">
    P is defined as the number of packs per patient per month</p>

</div>